Mortality in the United States - Are We Overlooking the Role of Metabolic Disease?

In 2019, American life expectancy was 78.8 years.

In 2020, it fell to 77.0. In 2021, it fell again, to 76.4.

That's 2.4 years gone in two years.

COVID-19 drove much of that drop. So did drug overdoses, along with other causes.

By 2024, life expectancy had recovered to 79.0 years.

Good news. But it's not the part I keep thinking about.

While everyone was watching the pandemic, the chronic metabolic diseases that have been building in this country for decades didn't go anywhere.

What Americans are dying from

According to the CDC, these were among the leading causes of death in 2024:

* Heart disease: 683,491

* Cancer: 619,876

* Stroke: 166,852

* Diabetes: 94,445

* Kidney disease: 55,081

We list them separately. The body doesn't.

Metabolic dysfunction feeds into several of these at once. Insulin resistance. High blood glucose. Visceral fat. High blood pressure. Chronic inflammation. One underlying problem, several diagnoses.

And it doesn't always show. Plenty of people with metabolic dysfunction aren't visibly overweight.

The metabolic connection

Type 2 diabetes raises the risk of heart disease and kidney disease. That's well established.

Excess body fat, and the hormonal and inflammatory changes that come with it, is linked to at least 13 types of cancer.

Cancers associated with overweight and obesity make up about 40% of cancer diagnoses in the U.S.

That doesn't mean obesity caused every one of them. It does show how much ground metabolic health covers.

I suspect improving it would do more for American longevity than we give it credit for.

What the pandemic showed us

People with diabetes and obesity were more likely to get seriously ill from COVID-19.

The pandemic also interrupted medical care, cut into physical activity, and made chronic disease harder to manage.

Questions about vaccine safety deserve real investigation, with properly controlled evidence. Rare serious reactions have been documented. But a rise in national deaths, on its own, can't tell us vaccines caused them.

What I keep coming back to is simpler. How sick we get often depends on how healthy we were going in.

Are we catching it too late?

Most of the time, we name a disease once it's obvious.

Insulin resistance can be there for years before anyone hears the words "type 2 diabetes" or "heart disease."

So I think we should be looking much earlier. Not just at individual diseases, but at the conditions that let several of them take hold.

Prevent metabolic dysfunction earlier in life, and you may see less heart disease, stroke, diabetes, kidney disease, and some cancers decades later. There's solid research behind prevention.

What we don't know yet is how much of America's total death toll earlier metabolic care could realistically prevent.

That's the question I'd like to see answered.

— Zsuzsu

Research and Sources

1. CDC: U.S. Mortality, 2021

2. CDC: U.S. Mortality, 2024

3. CDC: Deaths and Leading Causes

4. CDC: Obesity and Cancer

5. CDC: Trends in Obesity-Associated Cancers